Aortic remodeling in patients with aortic dissection after Frozen Elephant Trunk procedure

Background. Aortic dissection remains one of the most challenging cardiovascular pathologies for radical surgical treatment. The frozen elephant trunk (FET) procedure allows simultaneous reconstruction of the aortic arch and descending thoracic aorta. However, long-term outcomes are largely determined by postoperative aortic remodeling.

Aim: To compare aortic remodeling after implantation of dissection-specific versus conventional hybrid prostheses using a standardized protocol and to assess the incidence of specific complications – distal stent graft-induced new entry (dSINE) and endoleaks.

Material and Methods. This prospective single-center study included 106 patients with aortic dissection who underwent FET between 2014 and 2025. Patients were divided into two groups: Group 1 (n = 56) – “Soft Elephant Trunk” hybrid prosthesis (MedInzh, Russia); Group 2 (n = 50) – conventional hybrid prostheses (E-Vita Open Plus, Thoraflex Hybrid, Medtronic Valiant). Remodeling was assessed according to a patented protocol (RU 2841599 C1), including planimetry (area, perimeter) at 7 aortic levels and volumetry in 3 segments using CT before surgery, postoperatively, at 6 months, and annually up to 5 years. Remodeling was classified according to Dohle DS criteria as positive (PR), negative (NR), or stable (SR).

Results. At critical stent graft implantation levels (2–4), Group 1 showed a consistent decrease in NR and an increase in PR, whereas Group 2 demonstrated an irregular pattern with frequent NR episodes. Volumetric assessment revealed stable remodeling in Group 1, while Group 2 showed NR progression at 4–5 years. The 5-year incidence of dSINE was significantly lower in Group 1 (8.9% vs. 42.9%; p = 0.001). Use of a dissection-specific hybrid prosthesis was associated with a reduced risk of dSINE (OR 0.10; 95% CI 0.02–0.36; p = 0.001), while type B dissection increased the risk (OR 10.46; 95% CI 2.37–62.68; p = 0.004). Late (>5 years) type 1b endoleaks occurred more frequently in Group 2 (31.4% vs. 7.1%; p = 0.009).

 Conclusions. The use of dissection-specific hybrid prostheses in aortic dissection surgery provides more stable positive remodeling and reduces the incidence of dSINE and late endoleaks compared with conventional prostheses. The standardized planimetric and volumetric protocol allows reliable monitoring of remodeling and timely identification of indications for reintervention.

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